Predicting inhaler technique maintenance: An art or a science?

Introduction: Optimal inhaler technique is critical in effective asthma management. 50-90% of asthmatics do not have correct technique; 51% of patients fail to maintain it over time. Health care professionals need to be able to identify patients at risk of poor inhaler technique and suboptimal asthma management. Aim: To explore factors that influence inhaler technique maintenance in order to identify predictors of correct inhaler technique over time. Methods: Patient data (n=233) was utilized from a quality-controlled longitudinal community pharmacy database. Clinical, humanistic and economic outcomes (e.g asthma control, adherence, Perceived Asthma Control, Asthma Quality of Life, Asthma Knowledge) were collected. Correlational analysis and regression modelling were employed to determine potential predictors of inhaler technique maintenance. Results: At the initial visit, 29% of patients demonstrated correct technique (based on device-specific checklists), which increased to 100% after pharmacist intervention. One-month post- intervention, 48% of patients maintained correct technique. Dispensing records indicated 89% of patients were non-adherent and 61% were at risk of future non-adherence. Significant relationships were found between inhaler technique maintenance, future risk of non-adherence (p=0.008), adherence to preventer medications, (p=0.024), baseline inhaler technique (p Conclusion: Inhaler technique maintenance is more complex than learning a skill. Adherence is a possible predictor of inhaler technique maintenance. Future asthma management strategies need to address inhaler technique and adherence as one concept: the quality use of respiratory medicines.